| NPI | 1841300159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9700809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-051235) |
| 207P00000X Emergency Medicine (Licence: OH 35.051235) | |
| 207Q00000X Family Medicine (Licence: NC 9700809) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-10-27 |